The NIH takes on pregnancy-related health complications

Tens of thousands of American women suffer dangerous complications during pregnancy each year. Some die. Now the National Institutes of Health (NIH) has awarded $24 million in grant money to form a new center of excellence devoted to maternal health research and improvement. For more on that,  Federal Drive with Tom Temin spoke with Dr. Nahida Chakhtoura, the Chief of the NIH Pregnancy and Perinatology Branch.

Interview Transcript: 

Tom Temin And your branch lives in one of the institutes, correct?

Nahida Chakhtoura Correct. My branch, the pregnancy and perinatology branch is in the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Tom Temin Okay. Well, a lot of words to describe something very important. And there’s a parent program here that these grants come under called the Improve Program. So NIH and the Shriver Center were already on the beat, if you will, for pregnancy issues. Tell us about the Improve Program, first of all.

Nahida Chakhtoura Sure. So in response to the maternal health crisis that we had, the NIH launched the Improve Initiative, which is a multi-pronged initiative, implementing maternal health and pregnancy outcomes vision for everyone in 2019. This is an NIH-wide effort coordinated by a couple of institutes, including NICHD, the National Office of Research on Women’s Health and the National Institute of Nursing Research. But with many participating institutes as NIH. And the initiative focus is to reduce preventable causes of maternal morbidity and mortality, addressing disparities in maternal health outcomes, expanding implementation of evidence based maternal health care practices before, during and after pregnancy, building research capacity in community based organizations. Promoting access to maternal health care with innovative point of care technology, among other activities.

Tom Temin And you mentioned the crisis in the country. What makes it a crisis? I mean, it would be a percentage of population that is having this problem or the percentage of pregnancies that have this issue and what makes it a crisis in the United States? And where do we kind of rank worldwide on these types of problems?

Nahida Chakhtoura Compared to other high income countries? The United States has a higher rate of maternal death with more than 1200 such deaths occurring in 2021, the most in recent years where data is available. But in addition to that, each year, tens of thousands of Americans experience severe pregnancy related complications, which can raise the risk of future health concerns, including high blood pressure, diabetes and mental health conditions. And there are stark disparities in these maternal health outcomes by racial and ethnic groups age, education, socioeconomic status, as well as geographic regions.

Tom Temin Okay. So now that you are establishing a center of excellence and it’s really through a grant program, tell us what the Center of Excellence will specifically do under the Improve Project.

Nahida Chakhtoura So the Maternal Health Research Centers of Excellence is a new nationwide initiative to develop and evaluate innovative approaches to reducing pregnancy related complications and deaths and to promote maternal health equity. As mentioned earlier, we need to address the growing maternal health crisis in the United States by identifying evidence-based solutions to promote health equity and improve outcomes. And this initiative works collaboratively that includes community involvement in research so that the populations affected are part of the solution. And another component of the centers is that training the next generation of investigators to conduct maternal health research, addressing the needs of communities nationwide.

Tom Temin It sounds like the crisis that you described in pregnancy and illness and dangers associated with pregnancy are not equally distributed across the population?

Nahida Chakhtoura Correct. There are stark inequities in maternal health outcomes. For example, for Black women, they are three times more likely to die from pregnancy related causes than white women. There are also disparities, as mentioned earlier, by age, education, socioeconomic status and geographic regions. There are no single causes. And so we need multifaceted approaches to reduce these maternal health disparities and adverse outcomes. And what works for one community may not work for the other. For example, one of the main drivers of the health crisis is lack of access to maternity care. More than 2.2 million women in the U.S. live in maternity care deserts, with no access to obstetric care and even more live in areas with low or moderate access to maternity care. So one of the strengths of these research centers is that they are geographically spread across the U.S. and will include the populations at risk for adverse outcomes as community members of the research teams come up with solutions.

Tom Temin We’re speaking with Dr. Nahida Chakhtoura. She is the chief of the NIH Pregnancy and Perinatology Branch, part of the NICHD. And $24 million has gone out to grantees. Where did it go and what will they do first?

Nahida Chakhtoura So the research focus for these centers is broad. And so there are several programs listed as will be utilizing the funds for studies related to hypertension, postpartum care, diabetes and other initiatives. So the proposed projects, again, for each of the centers will be the focus of research of each individual center.

Tom Temin So these centers are teaching hospitals or academic hospitals or places like that.

Nahida Chakhtoura Mostly academic hospitals in partnership, again, with the communities that they serve.

Tom Temin And so these hospitals, then, if they’re in those communities where they serve, they could be near the so-called deserts that you say, of health care access.

Nahida Chakhtoura Absolutely. They would be involving populations that are in rural communities and/or even urban communities with obstetrical deserts.

Tom Temin Interesting. I guess maybe the cause of the obstetrical deserts is probably something that you’ll be researching, why there are so few obstetricians and so forth in those areas in the first place.

Nahida Chakhtoura The centers will be researching alternatives. Some centers may be researching alternatives to care. Each research center is partnering with community collaborators such as state, local policies, community health centers and faith based organizations so that they can work within their communities to address the needs of those communities.

Tom Temin And a lot of other NIH institutes are involved in this whole project, too, aren’t they?

Nahida Chakhtoura Yes, absolutely. The Improve Initiative includes multiple centers and institutes within NIH. So this is an NIH-wide activity that is being supported.

Tom Temin Now, you are an obstetrician yourself, correct?

Nahida Chakhtoura Yes, I am.

Tom Temin What is your hunch as to some of the possible causes of these disparate realities during pregnancy and unfortunate outcomes that are not equally distributed, but localized with certain types and population characteristics? What do you think’s going on here?

Nahida Chakhtoura As mentioned, we think that there are multiple factors that contribute to the disparities, including access to care, quality of care, underlying chronic conditions and structural factors such as implicit bias and others that could be contributing to the maternal health adverse outcomes as well as disparities.

Tom Temin But you’re going to find out one way or another through the centers of excellence.

Nahida Chakhtoura So these centers are to work on solutions as well to understand what works for communities and how we can address some of the barriers that some communities are facing.

Tom Temin And there’s follow on money if it becomes available through appropriations to keep building on these centers and the outcomes and the research. Correct?

Nahida Chakhtoura Yes. We funded the first year at $24 million as part of the Improve Initiative. And these awards are for seven years. And so the grants are expected to last seven years. And in total, if we pending availability of funds, we could have these centers for seven years.

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